Comparing case-control study for treatment of proximal tibia fractures with a complete metaphyseal component in two centers with different distinct strategies: fixation with Ilizarov frame or locking plates

Abstract

BackgroundThe purpose of this study was to compare two methods of stabilization for proximal tibia fractures (AO 41) with a complete metaphyseal component, external fixation with the Ilizarov wire frame, and internal fixation with locking plates.MethodsPatients from two level 1 trauma centers treated between 2009 and 2015 were included in a retrospective comparing cohort study. The first center stabilized the non-pathological, proximal tibia fractures exclusively with external fixation and the second with internal plating. Combined clinically and radiologically evaluated, bone healing was the primary outcome. The secondary outcomes included complications, range of motion (ROM) and axial alignment of the knee, the reoperation rate within 6 months, heterotopic ossifications (HTO), and signs of posttraumatic osteoarthritis (PTOA). A logistic regression analysis corrected for uneven distributed parameters.ResultsThe 62 patients treated with Ilizarov frame and the 68 patients treated with plate fixation were comparable regarding epidemiological parameters, injury characteristics, and comorbidity except for injury severity score (ISS) and smoking behavior. The time of healing was shorter in the group undergoing plate fixation (p = 0.041); however, the incidence of non-unions was equal. Furthermore, there was no difference regarding the rate of deep infections, thrombosis, alignment, reoperations, PTOA, and ROM. Heterotopic ossifications were more prevalent following plate fixation (13.2 vs 1.6%, p = .013). External fixation was associated with a higher rate of superficial infections (40.4 vs 2.9%, p = .000). The initial displacement, the incidence of deep infections, and the classification significantly influenced the incidence of non-unions in both groups (p < 0.02).ConclusionsFixation of proximal tibia fractures with plates resulted in a slightly shorter healing time compared to Ilizarov frame stabilization. Furthermore, the complication profiles differ with more heterotopic ossifications and less superficial infections following internal plating.Trial registrationDRKS, DRKS00013275, Registered 11/2/2017, Retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0792-3) contains supplementary material, which is available to authorized users.

Comparison between open reduction with internal fixation to circular external fixation for tibial plateau fractures: A systematic review and meta-analysis

“…Five studies [ 17 , 18 , 26 , 29 , 30 ] reported data on malunions. Our meta-analysis indicates circular external fixator compared to ORIF results in a significantly higher chance of developing malunion (OR, 2.56; 95%CI, 1.12–5.84; I 2 = 49%; p = 0.03) ( Fig 6A ).…”

“…Three studies [18,24,28] reported data on post-operative knee ranges of motion in degrees. The pooled mean difference did not demonstrate any significant difference in range of motion between the two treatment modalities (MD,2.28; 95% CI, -11.27 to 15.82; I 2 = 86%, p = 0.74) (Fig 3).…”

“…Our meta-analysis indicates circular external fixator compared to ORIF results in a significantly higher chance of developing malunion (OR, 2.56; 95%CI, 1.12-5.84; I 2 = 49%; p = 0.03) ( Fig 6A). Three studies [18,20,26] reported the incidence of non-unions in the two groups. Pooled analysis indicates no difference in the incidence of non-union with either methods of management (OR, 1.44; 95%CI, 0.14-14.27; I 2 = 74%; p = 0.76) ( Fig 6B) Five studies [16,18,21,22,25] reported the incidence of postoperative thromboembolism and four studies reported data on knee stiffness [18,23,28,29] in both study groups.…”

“…Three studies [18,20,26] reported the incidence of non-unions in the two groups. Pooled analysis indicates no difference in the incidence of non-union with either methods of management (OR, 1.44; 95%CI, 0.14-14.27; I 2 = 74%; p = 0.76) ( Fig 6B) Five studies [16,18,21,22,25] reported the incidence of postoperative thromboembolism and four studies reported data on knee stiffness [18,23,28,29] in both study groups. Metaanalysis demonstrated no difference in the incidence of postoperative thromboembolism (OR, 2.47; 95%CI, 0.89-6.84; I 2 = 10%; p = 0.08) ( Fig 7A) and knee stiffness (OR, 1.19; 95%CI, 0.32-4.40; I 2 = 42%; p = 0.79) ( Fig 7B) between ORIF and circular external fixator.…”

Recombinant Human BMP6 Applied Within Autologous Blood Coagulum Accelerates Bone Healing: Randomized Controlled Trial in High Tibial Osteotomy Patients

“…Based on historical data, the dynamics of HTO defect healing in the placebo group was expected to average around 20% at week 9 post-surgery, around 40% at week 14 post-surgery, and approximately 90% after 6 months. (21) The sample of 20 patients (ABGS/PBO randomized in 1:1 ratio) was selected to provide 80% power to detect an average difference between ABGS and PBO of around 30% in defect healing. The bonehealing acceleration effect was estimated using X-ray analyses according to the established radiological scoring system, (16,22) and the bone mineral density (BMD), which reflected the bone formation in the defect area, was measured by CT scans using ITK-SNAP program.…”